Abstract
Warner et al.’s study 1 has stimulated interesting conversations among our colleagues and we now write to articulate these thoughts. The study population comprised consultants and trainee doctors. It is not explained why specialty and associate specialist doctors were excluded. We opine that this group of doctors may be very experienced and hold a repository of knowledge of local health resources, valuable to the management of complex patients. As they are often in post and in a service for longer than trainees, their exclusion misses an opportunity to gauge continuity of care received by patients with medically unexplained symptoms.
A previous health strategy, No Health without Mental Health, 2 prioritised the need for services for persons with medically unexplained symptoms but progress has been painfully slow. Medically unexplained symptoms exist in every specialty of medicine and surgery. In some patients, they may co-exist across several physiological systems and are often associated with enduring non-physical health difficulties. This degree of complexity demands coherent patterns of care. Without the implementation of stepped, collaborative and integrated care, it is difficult to see how these patients may be better helped. Most doctors in the study viewed their role and treatments solely as pertained to their own specialty and not in a holistic way. 1
Doctors hinted at limited access to psychology and liaison psychiatry. 1 This may indeed be an impediment to equitable care. An initial rapid expansion of liaison psychiatry, seen over the past four to five years, focused on mental healthcare of the elderly and patients presenting at emergency departments to the possible detriment of patients with long-term conditions and medically unexplained symptoms. 3 It is our knowledge that these services are experiencing funding challenges. 3 This development cannot improve services for patients with medically unexplained symptoms.